Carcinoids and their variant endocrinomas. An analysis of 11842 reported cases

Endocrinocarcinomas consisting of carcinoids and their variant carcinomas with endocrine features are neoplasms of relatively rare occurrence but have often been reported in many countries and regions of the world. The largest series of 13715 cases from the United States was published in 2003. A total number of 11842 reported cases of endocrinocarcinomas from the Niigata Registry were divided into two groups: the carcinoid group (n = 10804) with the typical (n = 9430) and the atypical (n = 1374) series and the variant group (n = 1038). These cases came from 64 countries and reports were written in 17 different languages. They were statistically evaluated for comparison between the two groups or series in various aspects, including gender and age, tumor-size, rate of metastases, immunohistochemistry, and survival after curative resection. In the carcinoid group, more frequent cases were found in the digestive system (64.2%) than in the extradigestive system (35.8%). Organ distribution of carcinoid cases exhibited the most frequent site to be the respiratory system (19.8%), followed by the rectum (15.0%), jejunoileum (12.0%), stomach (11.4%), appendix (9.6%) and duodenum (8.3%). An extremely small number of cases (less than 0.7%) were found in the middle ear, testicle, kidney, and several others. The highest rate of metastases was noted in the ileocecum (75.3%), followed by the jejunoileum (65.2%), pancreas (64.2%), and larynx (61.4%). Small carcinoids with invasion confined to the mucosa and submucosa, indicated an unexpectedly high metastasis rate of 13.8% for lesions 20 mm or less, and 10.0% for those 10 mm or less, and 6.1% for those 5 mm or less. The carcinoid syndrome was found to occur at the rate of 7.7% of overall 11057 cases reported between 1953 and 2002, with the highest incidence of 28.8% in the 5-year period between 1963 and 1967, gradually decreasing down to 3.7% in the last 5 years. The 5-year survival rate after curative resection of lesions showed a significant difference between the carcinoid group and the variant group (82.0% vs 41.8%: P < 0.0001). In the former group, the 5-year survival rate showed a significant difference between cases with or without metastases (61.4% vs 95.7%: P < 0.0001). In the latter group, the 5-year survival rate was 74.5% for cases without metastases and 24.1% for those with metastases (P < 0.0001). The highest 5-year survival rate in the carcinoid group was noted in the ovary (93.6%), followed by the liver (92.6%), the respiratory system (89.7%), the appendix (89.5%), and the rectum (85.4%), while poor 5-year survival rates were recorded in the pancreas (43.2%), the esophagus (43.5%) and the larynx (47.6%). It should be emphasized that there is a significant statistical difference in many aspects between the carcinoid group and the variant group. The present study confirms that the malignant nature of these endocrine tumors is well reflected in their metastasis rates, even in small lesions with submucosal invasion, resulting in the 5-year survival rates of a significant difference among the groups or series.     

Lidocaine spray used to capture a live Clinostomum parasite causing human laryngitis

This case report describes a patient who developed Clinostomum laryngitis after eating raw fresh-water fish. Parasite removal was performed under general anesthesia using a laryngomicroscopic method. Because it was difficult to capture the worm intact using forceps, it was sprayed with 8% lidocaine solution. This immediately inhibited peristaltic movement of the parasite allowing easy retrieval without tearing any part of the organism, thus facilitating parasite identification.     

Expression and regulation of Na pump isoforms in cultured cerebellar granule cells

We investigated expression of Na pump isoforms in cultured cerebellar granule cells and measured in situ ion pump activities of the isoforms, to elucidate functions of Na pump isoforms in neurons. The cells expressed three Na pump isoforms (alpha1, alpha2 and alpha3 isoforms), however the alpha1 isoform acted as a main ion pump under basal conditions. The ion pump activity of the alpha3/ alpha2 isoforms increased remarkably after stimulation of the neurons with glutamate, therefore the alpha3/alpha2 isoforms as well as the alpha1 isoform acted as ion pumps after the stimulation. The glutamate effects were mainly mediated by non-NMDA receptors. These results suggest that alpha1 isoform and alpha3/alpha2 isoforms are functionally important under basal conditions and after neuronal excitation, respectively.     

Cardiovascular risk factors are really linked in the metabolic syndrome: this phenomenon suggests clustering rather than coincidence

BACKGROUND: The accumulation of cardiovascular risk factors can be seen in a single person but it needs to be determined if this occurs more frequently than might be explained by mere coincidence. METHODS: This study involved 119,412 adults: 41,819 males and 77,593 females, who were 40 years of age or older and who underwent an annual health examination. From the clinical and biochemical data, the actual prevalence of a combination of 3 or more factors: abnormal body mass index (> or =25.0), hypertension, high triglyceride (> or =150 mg/dl), low HDL cholesterol (<40 mg/dl) and abnormal fasting glucose metabolism (fasting blood sugar > or =110 mg/dl or HbA1c. > or =5.5%) was determined. Then, the prevalence of a corresponding combination of 3-5 factors was predicted from the prevalence of each factor on the assumption that their combination occurs as a result of coincidence. RESULTS: The criteria of metabolic syndrome (> or =3 risk factors) was met in 17,842 (14.9%) of the examinees. The actual prevalence of any combination of 3-5 factors of metabolic syndrome was more frequent than those expected to occur by coincidence (P < 0.001). When compared with the prevalence of the total examinees, the prevalence of obesity and insulin resistance was 2.5 and 2.9 times higher in metabolic syndrome compared to that in the total examinees but it was 1.7 to 2.1 times higher in hypertension and high triglyceride. The former two were clustering more than hypertension or high triglyceride in metabolic syndrome. Abnormal levels of serum creatinine and total cholesterol were found more often in metabolic syndrome. CONCLUSION: Combinations of risk factors of metabolic syndrome were found more frequently than coincidental phenomenon in the subjects from the general population. These finding suggest that these risk factors do cluster and obesity and insulin resistance were suggested to be linked with metabolic syndrome more than hypertension or high triglyceride.     

Application of Polyethylene Glycolic Acid Felt with Fibrin Sealant to Prevent Postoperative Pancreatic Fistula in Pancreatic Surgery

Objective

The purpose of this nonrandomized retrospective study was to report our new procedures using polyethylene glycolic acid (PGA) felt with fibrin sealant to prevent severe pancreatic fistula in patients undergoing pancreatic surgery.

Methods

From 2000 to 2008, 54 and 63 patients underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), respectively. Of those patients, we applied PGA felt with fibrin sealant to 18 PD patients and 26 DP patients. In PD patients, the PGA felt was wrapped around the pancreatic suture site, while in DP patients, the PGA felt was wrapped around the predictive division site. The pancreaticojejunostomy site in PD patients and the cut stump in DP patients were coated with fibrin sealant. We compared the occurrence rates for severe postoperative pancreatic fistula (POPF) that occurred after PD or DP both with and without our new procedures.

Results

Before introduction of our procedures, severe POPF developed in 14 of 36 PD patients (39%) and 10 of 37 DP patients (27%). In contrast, after introduction of our procedures, the incidence of POPF was only one in both of 18 PD (6%; P?=?0.016) and 26 DP (4%; P?=?0.017) patients.

Conclusion

In summary, our procedure using PGA felt with fibrin sealant may reduce the risk of severe POPF.     

Attenuation of adhesion formation after cardiac surgery with a chymase inhibitor in a hamster model

OBJECTIVE: Chymase is one of the inflammatory mediators and is released from mast cells, which are closely associated with adhesion formation. Chymase also activates transforming growth factor beta1, which promotes tissue fibrosis. However, the role of chymase in cardiac adhesion formation has not yet been elucidated. We have assessed whether a specific chymase inhibitor, Suc-Val-Pro-Phe(p) (OPh)(2), prevents postoperative cardiac adhesions in hamsters. METHODS: In 66 hamsters the epicardium was abraded, and then either chymase inhibitor or placebo was injected into the left thoracic cavity, leaving the pericardium open. Cardiac chymase activity, the level of transforming growth factor beta1 in the pleural fluid, and the density of epicardial mast cells were measured 3 days postoperatively. The degree of adhesion formation was evaluated macroscopically and histologically 2 weeks postoperatively by using a grading score ranging from 0 (no adhesions) to 4 (severe adhesions). RESULTS: The cardiac chymase activity and level of transforming growth factor beta1 were lower in the chymase inhibitor-treated group compared with in the placebo-treated group (45.8 +/- 18.7 vs 79.7 +/- 13.7 microU/mg protein [P <.025] and 15.6 +/- 6.5 vs 33.2 +/- 9.8 microg/mL [P <.01], respectively). The density of mast cells was higher in the placebo-treated group, and there was suppression to 60% of this value in the chymase inhibitor-treated group. The adhesion scores were lower in the chymase inhibitor-treated group compared with in the placebo-treated group (1.3 +/- 1.3 vs 3.0 +/- 1.1, P <.01). CONCLUSION: Use of a chymase inhibitor suppresses not only cardiac chymase activity but also the level of transforming growth factor beta1, and this results in a reduction in postoperative cardiac adhesion.     

Manserin as a novel histochemical neuroendocrine marker in prostate cancer

ObjectivesTo investigate the presence of manserin in human prostate cancers and to correlate manserin expression with pathologic outcomes and progression-free survival.MethodsEighty-seven patients with recent prostate cancer were classified into 4 groups based on Gleason score, and manserin immunohistochemistry was correlated with Gleason sum grade. To investigate the validity of manserin as a prognostic factor, the Cox proportional hazards regression model was performed on 48 patients in our cohort with T3 or T4 prostate cancer who were initially treated with androgen deprivation therapy.ResultsThe manserin-positive rates of patients with Gleason sums of 6, 7, 8, and ≥9 were 0%, 20.0%, 35.0%, and 48.1%, respectively. Manserin-positive rates were positively correlated with Gleason sums (P = 0.0001). Median times to cancer progression in groups with (n = 8) and without (n = 40) manserin expression were 8 months and 28 months, respectively (P = 0.01). Univariate Cox analysis revealed that manserin expression, clinical stage T4, and high Gleason sum were significantly associated with progression. Multivariate analysis revealed that only 2 factors, manserin expression (hazard ratio (HR) 4.99, P = 0.01) and clinical stage T4 (HR 4.77, P = 0.03), were independent risk factors for progression.ConclusionsThis is the first report of manserin expression in human prostate cancers. Manserin may serve as a marker of prostate cancer progression.